Nurse Practitioner Practice Authority

Nurse Practitioner Practice Authority

APRNs are a crucial component of the United States health system, offering patients increased access to less costly and quality care. However, the scope of guidelines on the scope of practice for nurse practitioners varies from one state to another. Some states grant  APRNs to full authority practice authority while other states limit the practice of APRNs by requiring them to have practice agreements with physicians. The purpose this assignment is to examine the practice authority and scope of practice difference among APRNs in North Carolina and Washington state, current legislation in North Carolina that supports full practice authority in and how APRNs with full practice authority benefits society and health care system.

The differences and similarities between practice authority and scope of practices in North Carolina and Washington state.

The American Association of Nurse Practitioners (AANP) describes as a registered APRN  with the training and licensure to offer holistic patient care. A nurse practitioner evaluates, diagnoses, treats and manages chronic, episodic and acute ailments. A nurse practitioner is a specialist in preventing disease and promoting health. A nurse practitioner can order, perform, oversee and interpret laboratory and diagnostic tests, make prescriptions of nonpharmacological and pharmacological agents and also counsel and educate patients(Barton Associates, 2017). Nurse Practitioner Practice Authority


APRNs in North Carolina have restricted practice authority. State laws require NPs to have written agreements with supervising physicians for certain elements of nursing care. NPs in North Carolina might provide services under the delegation of physicians and in compliance with collaborative practice agreements. They are not recognized as primary care providers.  Barton Associates (2019) alleges that as opposed to North Carolina laws, Washington state laws completely authorize APRNs to provide care, offer diagnoses and prescribe medications. NPs can autonomously offer diagnosis and treatment to patients without involvement of physicians and they are acknowledged as providers of primary care.

In regard to prescriptive authority, physician involvement is needed for APRN prescriptive authority in North Carolina.   The prescriptive authority of a nurse practitioner is outlined within the collaborative agreement with the physician. Nurse practitioners can prescribe schedule 11-V controlled drugs. In Washington, physician involvement is not required for prescriptive authority of NPs and they are allowed to prescribe schedule two to five controlled drugs.  Federal law necessitates that APRNs get a DEA number so as to prescribe controlled substances ((Barton Associates, 2019).

APRNs in both North Carolina have full authority to refer patients for physical rehabilitation, put signatures sign death certificates as well as placard forms for disabled persons (Barton Associates, 2019).  Education, licensure, and certification requirements are controlled state boards of nursing and there are differences in licensing requirements. In North Carolina and Washington, a nurse practitioner is required to have completed an accredited master’s program and graduate degree respectively in order to get licensure Both North Carolina and Washington require that an APRN have a national certification in his or her specialty so as to maintain APRN licensure.

Current legislation that supports full practice authority in North Carolina

The SAVE Act is current legislation in North Carolina APRNs that support APRNs to be given support full practice authority.  As Roberts (2019) indicates, the SAVE Act (SB 143/ HB 185) is designed to modernize healthcare through the removal of unnecessary and obsolete restrictions on APRNs. The SAVE Act removes requirements for the actions of nurse practitioners to overseen by physicians. The objective of the bill is to eliminate the requirement for  APRNs to enter into collaborative practice agreements with physicians to be able to treat patients and enable patients to easily access cost-effective care  It does not alter nurses’ scope of practice, but it merely eliminates obsolete and unnecessary requirements for physician supervision.

APRNs with full practice authority benefit society and health care system

With the looming shortages and increased health care demand, several states are searching for low-cost schemes to lessen the shortages.  A research study by Conover and Richards supports the statement that APRNs with full practice benefit society and health care system. The study aims to evaluate how regulations that are less restrictive for APRNs in North Carolina can influence the economy.  According to Conover and Richards (2015), due to the changes propelled by the affordable care act, it is crucial to have an understanding of the economic gains of alleviating the impending shortage of providers in North Carolina through greatly relying on APRNs via less restrictive regulation Nurse Practitioner Practice Authority

Evidence has shown that greater usage of APRNs can lead to improvements in patient outcomes as well as reductions in overall costs of health care. APRNs provide quality and safe care as that provided by physicians, and with full practice authority, they can offer cost-effective care and enable more people to access care ( Conover &  Richards 2015). The study supports the hypothesis that the removal of numerous restrictions on APRNs in North Carolina to offer them more liberty to practice as several other states would result in a surge in the APRNs accessible to assist alleviate the physicians’ shortage.


The practice authority APRNs in North Carolina significantly differs from the practice authority of APRNs in Washington state. APRNs in Washington state practice autonomously and prescribe medications without physician oversight. On the contrary, APRNs in North Carolina are not allowed to practice autonomously and they must be supervised by a collaborating physician when practicing and prescribing medications.  Removal of state restrictions and granting North Carolina APRNs full practice authority can benefit the society and health care system since full utilization of APRNs can lead to improvements in patient outcomes as well as reductions in overall costs of health care.


Barton Associates. (2019). Nurse Practitioners Scope of Practice Laws. Retrieved from

Barton Associates M. (2017). NP Scope of Practice vs. Independent Practice: What’s the Difference? Retrieved from

Conover, C., & Richards, R. (2015). Economic benefits of less restrictive regulation of advanced practice nurses in North Carolina. Nursing Outlook, 63(5): 585-592.

Roberts, J. (2019). SAVE ACT: Increasing Freedom for N.C. Nurses. Retrieved from


Nurse Practitioner Practice Authority